全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

LMN Facial Palsy in Pregnancy: An Opportunity to Predict Preeclampsia—Report and Review

DOI: 10.1155/2014/626871

Full-Text   Cite this paper   Add to My Lib

Abstract:

Facial paralysis is the most frequent unilateral cranial nerve pathology affecting pregnant population 2 to 4 times more often than the nonpregnant population. There exists an association with preeclampsia but this has largely been overlooked. Clinicians often dismiss it for idiopathic palsy as seen in the present case. A 30-year-old woman, Gravida 4, Para 3, presented at 26 weeks pregnancy with complaints of facial weakness, blurring of vision, altered taste sensation, increased noise sensitivity for 1 month, headache since 18 days, and vomiting since 2-3 days. Her pulse was 90/min, BP was 170/120, and RR was 18/min. Uterus was 18 weeks size and proteinuria++ was present. Ultrasonography revealed a 26 weeks fetus, severe bradycardia, and absent liquor. HELLP syndrome was diagnosed after investigations. Six units of fresh frozen plasma were transfused. An informed decision for termination of pregnancy was made. She delivered a 450?gram stillborn. The third stage was complicated with postpartum hemorrhage but it was managed successfully. Women with Bell’s palsy during pregnancy should be evaluated critically as in some it may precede preeclampsia which has serious maternal and fetal implications. Therefore, these women should be in regular followup of the obstetrician. 1. Introduction Facial paralysis is an entity that most neurologists and otolaryngologists are familiar with. It is the most common and frequent unilateral cranial nerve pathology. Most commonly it is idiopathic or Bell’s palsy named after Sir Charles Bell who first described this condition and also its association with pregnancy [1]. Bell’s palsy is also associated with preeclampsia but this has been overlooked in the past. The patients have not been followed by the neurologists for such an event. The obstetricians, who often recognize central facial paralysis in severe preeclampsia as a part of stroke, have failed to relate peripheral facial palsy to preeclampsia only to dismiss it for idiopathic palsy as seen in the present case. 2. Case A 30-year-old, gravida 4, para 3, woman presented in antenatal outpatient department (OPD) at 26 weeks pregnancy with complaints of facial weakness, blurring of vision, altered taste sensation, and increased noise sensitivity for 1 month. She had headache since 18 days and vomiting since 2-3 days. All her previous deliveries were at home. In her last delivery at term, she had a stillborn baby. The present case was diagnosed with hypertension when she was three months pregnant and took prescribed antihypertensive drugs for about two months. About twenty

References

[1]  C. Bell, The Nervous System of the Human Body, Longman, Hurst, Rees, Orme, Brown & Green, London, UK, 1830.
[2]  R. L. Hilsinger Jr., K. K. Adour, and H. E. Doty, “Idiopathic facial paralysis, pregnancy, and the menstrual cycle,” Annals of Otology, Rhinology and Laryngology, vol. 84, no. 4, part 1, pp. 433–442, 1975.
[3]  J. A. Martin, B. E. Hamilton, S. J. Ventura, et al., “Births: final data for 2009,” National Vital Statistics Reports, vol. 60, no. 1, pp. 1–70, 2011.
[4]  G. S. Gillman, B. M. Schaitkin, M. May, and S. R. Klein, “Bell's palsy in pregnancy: a study of recovery outcomes,” Otolaryngology, vol. 126, no. 1, pp. 26–30, 2002.
[5]  J. L. Shapiro, M. H. Yudin, and J. G. Ray, “Bell's palsy and tinnitus during pregnancy: predictors of pre-eclampsia? Three cases and a detailed review of the literature,” Acta Oto-Laryngologica, vol. 119, no. 6, pp. 647–651, 1999.
[6]  N. A. Falco and E. Eriksson, “Idiopathic facial palsy in pregnancy and the puerperium,” Surgery Gynecology and Obstetrics, vol. 169, no. 4, pp. 337–340, 1989.
[7]  C. J. Sweeney and D. H. Gilden, “Ramsay Hunt syndrome,” Journal of Neurology, Neurosurgery & Psychiatry, vol. 71, no. 2, pp. 149–154, 2001.
[8]  P. W. Davies, M. C. Vallejo, K. T. Shannon, A. J. Amortegui, and S. Ramanathan, “Oral herpes simplex reactivation after intrathecal morphine: a prospective randomized trial in an obstetric population,” Anesthesia & Analgesia, vol. 100, no. 5, pp. 1472–1476, 2005.
[9]  K. K. Adour, J. M. Ruboyianes, P. G. von Doersten et al., “Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial,” Annals of Otology, Rhinology and Laryngology, vol. 105, no. 5, pp. 371–378, 1996.
[10]  A. A. Bezjian, W. N. Spellacy, and W. A. Little, “Idiopathic Bell's palsy in pregnancy,” Journal of the Florida Medical Association, vol. 57, no. 4, pp. 25–27, 1970.
[11]  Y. B. David, J. Tal, L. Podoshin, et al., “Brain stem auditory evoked potentials: effects of ovarian steroids correlated with increased incidence of Bell's palsy in pregnancy,” Otolaryngology, vol. 113, no. 1, pp. 32–35, 1995.
[12]  I. Mylonas, R. K?stner, C. Sattler, F. Kainer, and K. Friese, “Idiopathic facial paralysis (Bell's palsy) in the immediate puerperium in a patient with mild preeclampsia: a case report,” Archives of Gynecology and Obstetrics, vol. 272, no. 3, pp. 241–243, 2005.
[13]  D. Shmorgun, W.-S. Chan, and J. G. Ray, “Association between Bell's palsy in pregnancy and pre-eclampsia,” Quarterly Journal of Medicine, vol. 95, no. 6, pp. 359–362, 2002.
[14]  Y.-C. Juan, H.-K. Au, J.-J. Hsu, P.-C. Ma, W.-M. Liu, and C.-J. Jeng, “Bell palsy and preeclampsia superimposed on chronic hypertension,” Taiwanese Journal of Obstetrics and Gynecology, vol. 49, no. 2, pp. 223–224, 2010.
[15]  S. Cabrera, C. Olarte, and C. Vargas, “Bells palsy and preeclampsia: case report,” Revista Peruana de Ginecología y Obstetricia, vol. 58, pp. 137–140, 2012.
[16]  O. Pourrat, J.-P. Neau, and F. Pierre, “Bell's palsy in pregnancy: underlying HELLP syndrome or pre-eclampsia?” Obstetric Medicine, vol. 6, no. 3, pp. 132–133, 2013.
[17]  K. Ragupathy and E. Emovon, “Bell's palsy in pregnancy,” Archives of Gynecology and Obstetrics, vol. 287, no. 1, pp. 177–178, 2013.
[18]  N. Mathieu and J.-F. Ledigabel, “Pre-eclampsia and facial paralysis,” Gynecologie Obstetrique Fertilite, vol. 39, no. 2, pp. e31–e33, 2011.
[19]  M. J. Ramsey, R. DerSimonian, M. R. Holtel, and L. P. A. Burgess, “Corticosteroid treatment for idiopathic facial nerve paralysis: a meta-analysis,” The Laryngoscope, vol. 110, no. 3, part 1, pp. 335–341, 2000.
[20]  M.-C. Hellebrand, U. Friebe-Hoffmann, H. G. Bender, G. Kojda, and T. K. Hoffmann, “Mona Lisa syndrome: idiopathic facial paralysis during pregnancy,” Zeitschrift fur Geburtshilfe und Neonatologie, vol. 210, no. 4, pp. 126–134, 2006.
[21]  E. Peitersen, “The natural history of Bell’s palsy,” The American Journal of Otology, vol. 4, no. 2, pp. 107–111, 1982.
[22]  C. Lee, X. Zhang, and W.-F. Kwan, “Electromyographic and mechanomyographic characteristics of neuromuscular block by magnesium sulphate in the pig,” British Journal of Anaesthesia, vol. 76, no. 2, pp. 278–283, 1996.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133